Disease Diplomacy: International Norms and Global Health Security by Sara Davies, Adam Kamradt-Scott, and Simon Rushton. Johns Hopkins University Press, 2015, 148 pp.
Composed by a team of experienced researchers in the field of biosecurity, Disease Diplomacy tells the compelling story of how the spread of disease, and global efforts to contain it, have evolved in an era of air travel and globalized trade. For the field of global health, the work provides a much-needed study of the lasting impacts of major global disease outbreaks during the last two decades and the emerging field of global health security.
Beginning with an overview of the history of global cooperation around preventing the spread of disease, Disease Diplomacy begins in the years leading up to the first International Sanitary Convention in 1851, through the founding of the World Health Organization in 1948 with considerable discussion around the drafting, and adoption of the International Health Regulations (IHR), looking at both their strengths and weaknesses. This background lays the foundation for in-depth analysis of the emergence of global norms.
With this foundational understanding of the climate surrounding global health, and in particular international coordination to prevent the spread of disease, the work looks at several instances in the last few decades where the existing IHR fell short and where global coordination was lackluster. The authors present a compelling case for the need for the IHR revision that took place in 2005, as well as discussion about improved international coordination after the revision, with clear areas still in need of improvement. These needed IHR revisions were brought about in an era in which controlling the spread of disease was increasingly thought of as a matter of security on a global stage, well beyond strictly an internal matter.
Specific incidents of disease outbreak discussed in detail include SARS, H5N1, and the swine flu. Through these discussions one continuous conversation around global disease, and in particular global disease reporting and monitoring under the auspice of the World Health Organization, emerges. The authors rightfully express frustration over discrepancies in both member states’ capacity to monitor and report health conditions and in their political will to report emerging outbreaks. Particularly in an area of global travel and trade, states often show a hesitance to acknowledge an incident of infectious disease when such an acknowledgement likely means some form of embargo or quarantine. This fear has greatly influenced the development of the international norm around reporting, asking for and providing assistance, and assigning responsibility.
The authors discuss at great length the process through which the new IHR were written, tested, and reviewed. As will likely come as no surprise to readers, the trend in globalization has made countries, perhaps more than ever, hesitant to adopt a strategy that could bring embarrassment to them on the global stage. Even with revised IHRs in place, the WHO recognized the need for further cooperation and has in recent years, despite having very limited recourse against states which are noncompliant, embraced its power of “fame and shame” to applaud nations which contribute to greater global health security and to shame those who fail to hold up their end of the deal. Perhaps considering the growing trend in embracing the WHO as an authority in global health security, a clear trend has emerged in nations eager to consult with the WHO when faced with a potential outbreak or even the rumor of an outbreak. This consultation presents the unique challenge of mobilizing sufficient resources to investigate and propose responses to potential outbreaks while maintaining no real ability to mandate further support from member states or ensure the compliance of states requesting consultation. In short, the WHO, largely through the development of a revised IHR, has greatly increased its ability to monitor the emergence of infectious disease and utilizes a global concern for health security to motivate action in the absence of actual authority. However, a lack of authority often leaves the WHO unable to mandate action, and disparities in national health resources present challenges to maintaining global surveillance.
The authors present a unique analysis of complex trends in global health security with a strong background in recent history. The team of authors represents backgrounds from medicine to law to international governance, creating a depth of analysis that will leave readers with a new appreciation not just for the formation of international norms around health security but also about international cooperation more broadly. Disease Diplomacy is a strong addition to the existing work around global cooperation regarding the spread and control of disease and no doubt will interest scholars of global health, international affairs, and health security. Potential readers would be wise not to let the relatively low page count deceive them. Disease Diplomacy is filled to the brim and may prove to be something of a dense read for those without sufficient interest in the field. With references spanning nearly 20 pages, Disease Diplomacy should be applauded for bringing together a wealth of data in a concise, well-written work that will no doubt remain relevant for years to come.
William Ettinghoff